Individual
JENNIFER MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1233 WILSON RD, WILMINGTON, OH 45177-8712
(513) 807-3554
Mailing address
1233 WILSON RD, WILMINGTON, OH 45177-8712
(513) 807-3554
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2713264
—
OH
Enumeration date
06/22/2014
Last updated
06/22/2014
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